McCaskill 8 Day - not needed - unopposedCANDIDATE
/ OFFICEHOLDER FORM CIOH
CAMPAIGN
FINANCE E T COVER SHEET PG I
The C/OH Instruction Guide
explains haw to complete this form. 1 Filer ID (Ethics Commission Filers) 2 Total pages filed:
3 CANDIDATE /
MS i MRS I iR FIRST MI
OFFICEHOLDER
OFFICE USE ONLY
�
NAME-
.
elved
NICKNAME LAST" SUFFIX
FoR
CAN DIDATE /
ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE (}OFFICEHOLDER
8 0
11
MAILING
ADDRESS
OFFICE OF CITY SECRETARY
Change of Address
!
S CANDIDATE/
AREA CODE PHONE NUMBER EXTENSION DateHa
Doke Han delivered or Oala Postmarked
{ o t
PPHONEFHOLDER
6 CAMPAIGN
-w — Receipt Ar Amount 1
MS t RS MR FIRST MI
TREASURER
NAME.........,
�. .........,, ......,.....,,.. Data Processed
NICKNAME LAST SUFFIX „
Date Imaged
rA
7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE, ZIP CODE
TREASURER
ADDRESS
Qoj i 1
(Residence or Business)
t' 6
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
iqa — 9155,0
9 REPORT TYPE
January 15 30th day before election Runoff ti 18th day after campaign
t
r treasurer appointment
(Officeholder Only)
July Is Exceeded Modified Report C/OH FR)
I 8th day before election Final (Attach -
®'
Reporting Limit
10 PERIOD
Month Day Year Month DayYear
COVERED
y
'd THROUGH t csD C
11 ELECTION
ELECTION DATE ELECTION TYPE
❑ Primary Runoff ❑ Other
Month Day Year
Description
General F Special
12 O OFFFICE
_
OFFICE HELD (if any} 13 OFFICE SOUGHT if known)
14 NOTICE FROM
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS Zd(,tEVTWOR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT
POLITICAL
CANDIDATE I OFFICEHOLDER, THESE EXPENDnrunES MAY HAVE BEEN MADE WiTHour THE CANDIDATE'S OR OFFICEHOLDER'S KNOWLEDGE OR
COMMITTEE(S)
CONSENT.
CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES.
COMMITTEE TYPE COMMITTEE NAME
GENERAL COMMITTEE ADDRESS
Additional Pages
SPECIFIC COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
C70 TO PAGE
Forms provided by Texas Ethics
Commission www.ethics.state.tx.us Revised 8/17/2020
CANDIDATE / OFFICEHOLDER
FORM C/OH
CAMPAIGN FINANCE REPORT
COVER SHEET PG 2
15 C/OH NAME
16 File ID (Ethics Commission Filers)
Cp's A% u--
17 CONTRIBUTION
1, TOTAL UNITEMIZED POLITICAL CONTRIBUTIONS (OTHER THAN
TOTALS
PLEDGES, LOANS, OR GUARANTEES OF LOANS, OR
CONTRIBUTIONS MADE ELECTRONICALLY)
2. TOTAL POLITICAL CONTRIBUTIONS
$
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
100 co
EXPALSENDITURE
TOT
— -- — ---- - ------------- --- — ------------ . ........
3. TOTAL UNITEMIZED POLITICAL EXPENDITURE.
$
4. TOTAL POLITICAL EXPENDITURES
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
BALANCE OF REPORTING PERIOD $
OUTSTANDING 6, TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD $
18 SIGNATURE I swear, or affirm, under penalty of perjury, that the accompanying report is true and correct and includes all information
required to be reported by me under Title 15, Election Code.
Signature of Candidate or Officeholder
[KTHERESA K HOWAIRID
tj �
(1) Affidavit Notary PubItC, =State, of Texas
Notaq ltD))#: 1216
6t3T
mmisr Jon VIre 3120
My commictinn rV.4—
E 907. 25
NOTARY STAMP/ SEAL
Sworn to and subscribed before me by _!� �Jv'A:_vq r4 C�.Q—S (A k this the day of A c3c"%
20 —2AL—, to certify which, witness my hand and seal of office.
® n 9%— V —1 V, . " 2, N dkmr Lk
Signature of officer administering oath Printed name of officer administering oath
'00252=
My name is and my date of birth is
My address is
(street) (city) (state) (zip code) (country)
Executed in County, State of on the _ day of 20,__.
(month) (year)
Forms provided by Texas Ethics Commission www. ethics, state. tx. us Revised 8/17/2020
SUBTOTALS
C/OH
FORM C/OH
COVER
SHEET PG 3
19
FILER NAME
20 Filer ID (Ethics Commission Filers)
21
SCHEDULE SUBTOTALS
SUBTOTAL
NAME OF SCHEDULE
AMOUNT
1
SCHEDULEAI:
MONETARY POLITICAL CONTRIBUTIONS
$
Z
SCHEDULEA2: NON -MONETARY (IN -KIND) POLITICAL CONTRIBUTIONS
$
3•
SCHEDULE B:
PLEDGED CONTRIBUTIONS
$
4,
SCHEDULE E:
LOANS
$
5.
SCHEDULE F1:
POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
6.
�l SCHEDULE F2:
UNPAID INCURRED OBLIGATIONS
$
T
1 SCHEDULE F3:
PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS
$
8.
SCHEDULE F4:
EXPENDITURES MADE BY CREDIT CARD
$
9.
El SCHEDULE G:
POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS
$
10.
E1 SCHEDULE H:
PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF CfOH
$
11.
SCHEDULE I: NON -POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
12.
SCHEDULE K:
INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED
$
TO FILER
Forms provided by Texas Ethics Commission www. ethics. state. tx.us
Revised 8/17/2020
MONETARY POLITICAL CONTRIBUTIONS SCHEDULE Al
If the requested information is not applicable, DO NOT include i in the report.
The Instruction Guide explains how to complete this form. 1 Total pages Schedule Al;
FILER NAME 3 Filer ID (Ethics Commission Filers)
t t
Date 5 Full name of contributor ❑ out-of-state PAC (IL #: } 7 Amount of contribution {$)
► T m Qj
Contributor address; City; State; Zip Code
$ 1 t
8 Principal occupation ( Job title (See Instructions) g Employer (See Instructions)
Date Full name of contributor ❑ out-of-state PAC 4irr: Amount of contribution ($)
Contributor address; City; State; Zip Code
Principal occupation ( Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor ❑ out-of-state PAC (I®#. } Amount of contribution ($)
Contributor address„ CityState; Zip Code
Principal occupation ( Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor ❑ out-of-state PAC (ID#:._. ._ ) Amount of contribution ($)
Contributor address; cityState; Zip Code
Principal occupation / Job title (See Instructions) Employer (See Instructions)
ADDITIONAL COPIESI SCHEDULEAS
If contributor is out-of-state PAC, please see Instruction guide for additional reporting requirements.
Forms provided by Texas Ethics Commission www.ethics.state. tx.us Revised 8/17/2020
NON -MONETARY (IN -KIND) POLITICAL
CONTRIBUTIONS
SCHEDULE A2
If the requested information is not applicable, DO NOT include this
page in the report.
----- — -------
The Instruction Guide explains how to complete this for
I Total pages Schedule A2:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEZED IN -KIND POLITICAL CONTRIBUTIONS
$
5 Date 6 Full name of contributor ❑ out-of-state PAC (ID#:
8 Amount of 9 In -kind contribution
Contribution $ I description
7 Contributor address; City; State; Zip Code
Check if travel outside of Texas. Complete Schedule T.
10 Principal occupation / Job title (FOR NON -JUDICIAL) (See Instructions) 11
Employer (FOR NON-JUDICIAL)(See Instructions)
12 Contributor's principal occupation (FOR JUDICIAL) 13
Contributor's job title (FOR JUDICIAL) (See Instructions)
14 Contributor's employer/law firm (FOR JUDICIAL) 15
1_11_1111111
Law firm of contributor's spouse (if any) (FOR JUDICIAL)
16 If contributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL)
- -----------------
Date Full name of contributor ❑ out-of-state PAC
— - — — ------------------
Amount of In -kind contribution
Contribution $ I description
I Contributor address; City; State; Zip Code
Check if travel outside of Texas. Complete Schedule T
Principal occupation I Job title (FOR NON -JUDICIAL) (See Instructions)
Employer (FOR NON-JUDICIAL)(See Instructions)
—
Contributor's principal occupation (FOR JUDICIAL)
- - — ------ ........ —_
Contributor's job title (FOR JUDICIAL) (See Instructions)
11-- --- - ----- - --------- - ------- -_ - - - ---------
Contributor's employer/law firm (FOR JUDICIAL)
------
Law firm of contributor's spouse {if any(FOR JUDICIAL)
1 - - -------- -
If contributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULEAS NEEDED
If contributor is out-of-state PAC, please see Instruction guide
for additional reporting requirements.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us
Revised 8/17/2020
PLEDGED CONTRIBUTIONS
-----------
SCHEDULE B
If the requested information is not applicable, DO NOT include this page in the report.
I Total pages Schedule 13�
The Instruction Guide explains how to complete this form.
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEZED PLEDGES
$
-----------
5 Date 6 Full name of pledger ❑ out-of-state PAC (10#:)
----- - - - -----
8 Amount I 9 In -kind contribution
of Pledge $ description
7 Pledger address; City; State;
Zip Code
Check if travel outside of Texas. Complete Schedule T
--- -------------_ --
10 Principal occupation / Job title (See Instructions) 11
Employer (See Instructions)
Date Full name of pledger E] out-of-state PAC (10#:_Amount In -kind contribution
_. .
. . ...........
of Pledge $ I description
Pledgor address; City; State;
Zip Code
(,,Check if travel outside of Texas. Complete Schedule T
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date Full name of pledger ®out-of-state PAC
Amount of In -kind contribution
Pledge $ description
Pledgor address; City; State;
Zip Code
Check if travel outsi do of Texas. Complete Schedule T.
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
- — ---- — - -- - ------------- -----------
Date Full name of pledger out-of-state PAC Amount of I In -kind contribution
Pledge $ description
...........
Pledgor address; City; State;
Zip Code
E]Check if travel Outside of Texas, Complete Schedule T
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULEAS NEEDED
If contributor is out-of-state PAC, please see Instruction guide for additional reporting requirements.
Revised 8/1712020
Forms provided by Texas Ethics Commission www.ethics.state.tx.us
LOANS
SCHEDULE E
If the requested information is not applicable, DO NOT include this page in the report.
I Total pages Schedule E:
The Instruction Guide explains how to complete this form.
2 FILER NAME
3 Filer IS (Ethics Commission Filers)
4 TOTAL OF UNITEZED LOANS
5 Date of loan 7 Name of lender
E] out-of-state PAC (11,W 9 LoanAmount($)
............
6 Is lender Lender address;
city; State; Zip Code 10 Interest rate
a financial
Institution?
11 Maturity date
Y N
12 Principal occupation Job title (See Instructions)
13 Employer (See Instructions)
----------
14 Description of Collateral
15 Check if personal funds were deposited into political
none
F] account (See Instructions)
16 GUARANTOR 17 Name of guarantor
19 Amount Guaranteed ($)
INFORMATION
18 Guarantor address;
City; State; Zip Code
El not applicable
20 Principal Occupation (See Instructions)
21 Employer (See Instructions)
- --------------
Date of loan Name of lender
El cut -of -state PAC Loan Amount ($)
..........
Is lender Lender address;
City; State; Zip Code Interest rate
a financial
Institution?
Maturity date
Y N
- ----- ---- - - ------------- - -
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
-- —
Description of Collateral
— ------
Check if personal funds were deposited into political
none
account (See Instructions)
GUARANTOR Name of guarantor
Amount Guaranteed ($)
INFORMATION
Guarantor address;
City; State; Zip Code
not applicable
Principal Occupation (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If lender is out-of-state PAC, please
see Instruction guide for additional reporting requirements.
Fnrmq nrnvirip.rl by Tpyaq Fthirn Cnmmi-qinn
www. ethics. state.tx. us Revised 8/17/2020
POLITICAL EXPENDITURES MADE SCHEDULE F1
FROM POLITICAL CONTRIBUTIONS
If the requested information is not applicable, DO NOT include this page in tereport.
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan RepaymenVReimbumement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (enters category not listed above)
Credit Card Payment The Instruction Guide explains how to complete this form.
1 Total pages Schedule FI: 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
'5� es
4 Date 5 Payee name
Ce*SLkk%-%-
6 Amount ($) 7 Payee address; City; State; Zip Code
(AOk 9QTX,)lxA'-"'-C ILW� 57oltA-4-1-j%.�vC 7--X '-jWar0p
8 (a) Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE
OF WoZ� r-kC-rej�'
EXPENDITURE
(C) Check if travel outside of Texas. Complete Schedule T El Check if Austin, TX, officeholder living expense
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/01-1
Date Payee name
Amount Payee address; City; State; Zip Code
— -- — --------------------- — -----
Category (See Categories listed at the top of this schedule) Description
PURPOSE
OF
EXPENDITURE
ElCheck I f travel ou tside of Texas . Complete Schad ule T El Check if Austin, TX, officeholder living expense
Complete QNLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
--------------
. . .........
Date Payee name
Amount Payee address;City; State; Zip Code
Category (See Categories listed at the top of this schedule) Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas. Complete SchedulsT Check if Austin, TX, officeholder living expense
Complete ONLY— if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/011
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/1712020
UNPAID INCURRED OBLIGATIONS SCHEDULE F2
If the requested information is not applicable, DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX I 0(a)
Advertising Expense Event Expense Loan Repaymani/Reirnbursement Solicitationd'undrarsing Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (enter a category not listed above)
The Instruction Guide explains how to complete this form.
I Total pages Schedule F2, 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
...........
4 TOTAL OF UNITEMIZED UNPAID INCURRED OBLIGATIONS $
5 Date 6 Payee name
7 Amount 8 Payee address; City; State; Zip Code
9 TYPE OF
EXPENDITURE E,] Political El Non -Political
10 (a) Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas. Complete Schedule T. Check if Austin, To, officeholder living expense
11 Complete ONLY if direct Candidate I Officeholder name Office sought Office held
expenditure to benefit C10H
Date Payee name
Amount Payee address; City; State; Zip Code
TYPE OF Non -Political
EXPENDITURE Political
Category (See Categories listed at the top of this schedule) Description
PURPOSE
OF
EXPENDITURE
ElCheck if travel outside of Texas. Complete Schedule T. Check if Austin, To, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit CIOH
. . . ........ ..... _""' — — -----
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
PURCHASE OF INVESTMENTS MADE SCHEDULE F3
FROM POLITICAL CONTRIBUTIONS
If the requested information is not applicable, DO NOT include this page in tereport.
1 Total pages Schedule F3:
The Instruction Guide explains how to complete this form.
2 FILERNAME 3 Filer ID (Ethics Comm Ission Filers)
4 Date 5 Name of person from whom investment is purchased
6 Address of person from whom investment is purchased; City; State; Zip Code
7 Description of investment
8 Amount of investment
— ------ — ---------- ------ ----------
Date Name of person from whom investment is purchased
............ ...... .........
Address of person from whom investment is purchased; City; State; Zip Code
Description of investment
Amount of investment
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
EXPENDITURES MADE BY CREDIT CARD SCHEDULE F4
If the requested information is not applicable, DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX 10(a)
Advertising Expense Event Expense Loan RepaymeriVRairribursement Solicitation/Fund raising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services SalariesNVages/Contract Labor Other (enter a category not listed above)
The Instruction Guide explains how to complete this form.
I Total pages Schedule FC 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEM IZED EXPENDITURES CHARGED TO A CREDIT CARD $
5 Date 6 Payee name
— ----- . ..... _ ------ - ---- - ---------- ------ - — ----
7 Amount 8 Payee address; City; State; Zip Code
9 TYPE OF PENDITURE EXPolitical Non -Political
- - - ------ - - - ---------------- -
10 (a) Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE
OF
EXPENDITURE
(c) ❑ Check iftra,el outside ofTexas. Complete Schedule T ❑ Check if Austin, TX, officeholder living expense
11 Candidate / Officeholder name Office sought Office held
Complete QNIY if direct
expenditure to benefit CIOH
Date Payee name
___ — ------------- - — - — --------
Amount Payee address; City; statep Zip Code
TYPE OF
EXPENDITURE Political L1 Non -Political
Category (See Categories listed at the Lop of this schedule) Description
PURPOSE
OF
EXPENDITURE
Check if travel outside ofTexas. Complete Schedule T. Check if Austin, To, officeholder living expense
Candidate / Officeholder name Office sought Office held
Complete PNLY if direct
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
POLITICAL EXPENDITURES MADE FROM
SCHEDULE G
PERSONALFUNDS
If the requested information is not applicable, DO NOT include this page in tereport.
- --- --- ---------
- -----
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense
Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking
Fees Office Overhead/Rental Expense Transportation Equipment& Related Expense
Consulting Expense
Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made
By GINAwards/Mennorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services SalariesNVages/Contract Labor Other (enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
I Total pages ScheduleG:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date
5 Payee name
6 Amount
7 Payee address; City; State; Zip Code
Ratmbursementfrom
political contributions
intended
--
8
- - - -------------------------
(a) Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE
OF
EXPENDITURE
(c) Check ifiray.1 oulsideof-texas. Complete Schedule T Check if Austin, TX, officeholder living expense
9
Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date
Payee name
Amount
Payee address; City; State; Zip Code
Reimbursement from
political contributions
intended
Category (See Categories listed at the top of this schedule) Description
PURPOSE
OF
EXPENDITURE
71 Check if travel outside ofTexas. Complete Schedule T. [71 Check if Austin, TX, officeholder living expense
Candidate / Officeholder name Office sought Office held
Complete ObILY if direct
expenditure to benefit C/OH
-- ------ - ----- -- -- - -------
Date
Payee name
Amount
Payee address; City; State; Zip Code
Reimbursement from
political contributions
intended
Category (See Categories listed M the top of this schedule) Description
PURPOSE
OF
EXPENDITURE
Ch eck if travel on ei de of Texas . Complete S chedule T. E:1 Check if Austin, TX, officeholder living expense
— — - — --------- — ------
Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission yvww.ethics.state.tx.us Revised 8/17/2020
PAYMENT MADE FROM POLITICAL CONTRIBUTIONS
SCHEDULE H
TO A BUSINESS OF C/OH
If the requested information is not applicable, DO NOT include this page in the report.
— — --------
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense
Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking
Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense
Food/Beverage Expense Polling Expense Travel In District
Contributions/Conations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services SalarieslWages/Contract. Labor Other (enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form
1 Total pages Schedule H:
2 FILER NAME(Ethics ID Commission Filers)
4 Date
Business name
6 Amount
7 Business address; City; State; Zip Code
8
(a) Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE
OF
EXPENDITURE
(c) ❑ Check if travel outside of Texas. Complete Schedule T. E-1 Check if Austin, TX, officeholder living expense
. ....
9 Complete ONLY if direct
.... . . .... . .....
Candidate / Officeholder name Office sought Office held
expenditure to benefit C/01-1
Date
Business name
Amount
Business address; City; State; Zip Code
Category (See Categories listed at the top of this schedule) Description
PURPOSE
OF
EXPENDITURE
ElCheck if travel outside ofTexas. Complete Schedule T. Check if Austin, To, ofticevinmm living expense
Complete QNLY if direct
Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
. . .................... — -----
Date
Business name
Amount
. ...... — -----
Business address; City; State, Zip Code
--- -------
Category (See Categories listed at the top of this schedule) Description
PURPOSE
OF
EXPENDITURE
E:1 Check if travel outside of Texas. Complete Schedule T Check if Austin, TX, officeholder living expense
Complete ONLY if direct
Candidate / Officeholder name Office sought Office held
expenditure to benefit C/01-1
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/1712020
NON -POLITICAL EXPENDITURES
MADE FROM
POLITICAL CONTRIBUTIONS SCHEDULEI
If the requested information is not applicable, DO NOT include thisin the report.
The Instruction Guide explains how to complete this form.
1 Total pages Schedule l� 2
FILERNA E 3 FllerlD (Ethics Commission Filers)
Date 5
Payee name
Amount ($) 7
Payee address''.:; City State Zip Code
(a)Category (See "instructions for examples of acceptable (b) Description (See instructions regarding type of information
PURPOSE
categories.) required.)
F
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City State Zip Code
Category (See instructions for examples of acceptable Description (See instructions regarding type of information
PURPOSE
categories.) required.)
F
EXPENDITURE
Late
Payee name
Amount ($)
---,,,,A. __ - _
Payee address; City State Zip Code
POSE
PURF
Category (See instructions for examples of acceptable Description (See instructions regarding type of information
O
categories.) required.)
EXPENDITURE
. .�....
Date
Payee name
Amount ($}
Payee address; City State Zip Code
Category (See instructions for examples of acceptable Description (See instructions regarding type of information
PURPOSE
categories.) required.)
F
EXPENDITURE
ATTACH ADDITIONALI THIS
Forms provided by Texas Ethics Commission wormethics. state. tx.us Revised 8/17/2020
INTEREST, CREDITS, GAINS, REFUNDS, AND
CONTRIBUTIONS RETURNED TO FILER
SCHEDULE K
If the requested information is not applicable® DO NOT include this page in the report.
I Total pages Schedule K:
The Instruction Guide explains how to complete this form.
- —
2 FILER NAME
--------
3 Filer ID (Ethics Commission Filers)
4 Date 5 Name of person from whom amount is received
8 Amount
6 Address of person from whom amount is received; City;
State; Zip Code
7 Purpose for which amount is received ❑
Check if political contribution returned to filer
Date Name of person from whom amount is received
Amount
.......... ......
Address of person from whom amount is received; City;
State; Zip Code
Purpose for which amount is received
Check if political contribution returned to filer
Date Name of person from whom amount is received
Amount
Address of person from whom amount is received; City;
State; Zip Code
..... - --- — ------------
Purpose for which amount is received ❑
— ------
Check if political contribution returned to filer
Date Name of person from whom amount is received
Amount
Address of person from whom amount is received; City;
State; Zip Code
Purpose for which amount is received ❑
Check if political contribution returned to filer
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us
Revised 8/17/2020
IN -KIND CONTRIBUTIONS OR POLITICAL EXPENDITURES
SCHEDULE T
FOR TRAVEL OUTSIDE OF TEXAS
If the requested information is not applicable® DO NOT include this page in the report.
1 Total pages Schedule
T:
The Instruction Guide explains how to complete this form.
2 FILER NAME 3 Filer ID (Ethics Commission
Filers)
4 Name of Contributor/ Corporation or Labor Organization/ Pledger /Payee
5 Contribution / Expenditure reported on:
Schedule A2 Schedule B Schedule B(J) Schedule C2 Schedule D
Schedule F1
Schedule F2 Schedule F4 Schedule G [j Schedule H Schedule COH-LIC Schedule B-SS
6 Dates of travel 7 Name of person(s) traveling
8 Departure city or name of departure location
9 Destination city or name of destination location
-- 10 Means of transportation 11 Purpose of travel (including name of conference, seminar, or other event)
Name of Contributor! Corporation or Labor Organization / Pledger (Payee
Contribution / Expenditure reported on:
Schedule A2 Schedule B E] Schedule B(J) Schedule C2 ❑ Schedule D
Schedule F1
Schedule F2 Schedule F4 Schedule G Schedule H ❑ Schedule COH-LIC E] Schedule E3-SS
Dates of travel Name of person(s) traveling
Departure city or name of departure location
Destination city or name of destination location
Means of transportation Purpose of travel (including name of conference, seminar, or other event)
. ..... . ....... . ..... __
— - - - - ----- -------- - --
Name of Contributor / Corporation or Labor Organization I Pledger / Payee
Contribution / Expenditure reported on:
Schedule A2 ❑ Schedule B E] Schedule B(J) Schedule C2 E] Schedule D
Schedule F1
❑ Schedule F2 ❑ Schedule F4 Schedule G Schedule H Schedule COH-LIC
Schedule B-SS
Dates of travel Name of person(s) traveling
Departure city or name of departure location
Destination city or name of destination location
Means of transportation Purpose of travel (including name of conference, seminar, or other event)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www. ethics. state tx. us
Revised 8/17/2020
CANDIDATE/ OFFICEHOLDER REPORT -
DESIGNATION OF FINAL REPORT FORM
The Instruction Guide explains how to complete this form,
Complete only if "Report Type" on page 1 is marked "Final Report"
I C/01-1 NAME 2 Filer ID (Ethi- Cw=i-m, Her.)
I do not expect any further political contributions or political expenditures in connection with my candidacy. I understand that
not accept any
campaign contributions or make any campaign expenditures without a campaign treasurer appointment on file.
4 FILER WHO IS NOT AN OFFICEHOLDER
.. Complete A & B below only if you are not an officeholder.
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INTSIM-y". am - I - - ;M f- 9 #i 0
1 have unexpended contributions or unexpended interest or income earned from political contributions. I understand that I
may not convert unexpended political contributions or unexpended interest or income earned on political contributions to
personal use. I also understand that I must file an annual report of unexpended contributions and that I may not retain
unexpended contributions or unexpended interest or income earned on political contributions longer than six years after
filing this final report. Further, I understand that I must dispose of unexpended political contributions and unexpended
interest or income earned on political contributions in accordance with the requirements of Election Code, § 254.204.
Check only one:
= I do not retain assets purchased with political contributions or interest or other income from political contributions.
I do retain assets purchased with political contributions or interest or other income from political contributions. I understand
that I may not convert assets purchased with political contributions or interest or other income from political contributions to
personal use. I also understand that I must dispose of assets purchased with political contributions in accordance with the
requirements of Election Code, § 254.204.
5 OFFICEHOLDER
.. Complete this section only if you are an officeholder --
I am aware that I remain subject to filing requirements applicable to an officeholder who does not have a campaign treasurer or
file. I am also aware that I will be required to file reports of unexpended contributions if, after filing the last required report as
an officeholder, I retain political contributions, interest or other income from political contributions, or assets purchased with
political contributions or interest or other income from political contributions.
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Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020